Transitioning to Palliative Care in an Italian Cardiac Intensive Care Unit Network.

Journal

American journal of critical care : an official publication, American Association of Critical-Care Nurses
ISSN: 1937-710X
Titre abrégé: Am J Crit Care
Pays: United States
ID NLM: 9211547

Informations de publication

Date de publication:
01 Mar 2024
Historique:
medline: 1 3 2024
pubmed: 1 3 2024
entrez: 29 2 2024
Statut: ppublish

Résumé

Recent data indicate that end-of-life management for patients affected by acute decompensated heart failure in cardiac intensive care units is aggressive, with late or no engagement of palliative care teams. To assess current palliative care and end-of-life practices in a contemporary Italian multicenter registry of patients with cardiogenic shock due to acute decompensated heart failure. A survey-based approach was used to collect data on palliative care and end-of-life management practices. The AltShock-2 registry enrolled patients with cardiogenic shock from 12 participating centers. A subset of 153 patients with cardiogenic shock due to acute decompensated heart failure enrolled between March 2020 and March 2023 was analyzed, with a focus on early engagement of palliative care teams and deactivation of implantable cardioverter-defibrillators (ICDs). "Do not resuscitate" orders were documented in patient records in only 5 of 12 centers (42%). Palliative care teams were engaged for 21 of 153 enrolled patients (13.7%). Among the 51 patients with ICDs, 6 of 17 patients who died (35%) had defibrillator deactivation. Of the 17 patients who died, 13 died in the hospital and 4 died within 6 months after discharge; 1 patient had ICD deactivation supported by palliative care services at home. Therapy-limiting practices, including ICD deactivation, are not routine in the Italian centers participating in this study. The results emphasize the importance of integrating palliative care as a simultaneous process with intensive care to address the unmet needs of these patients and their families.

Sections du résumé

BACKGROUND BACKGROUND
Recent data indicate that end-of-life management for patients affected by acute decompensated heart failure in cardiac intensive care units is aggressive, with late or no engagement of palliative care teams.
OBJECTIVE OBJECTIVE
To assess current palliative care and end-of-life practices in a contemporary Italian multicenter registry of patients with cardiogenic shock due to acute decompensated heart failure.
METHODS METHODS
A survey-based approach was used to collect data on palliative care and end-of-life management practices. The AltShock-2 registry enrolled patients with cardiogenic shock from 12 participating centers. A subset of 153 patients with cardiogenic shock due to acute decompensated heart failure enrolled between March 2020 and March 2023 was analyzed, with a focus on early engagement of palliative care teams and deactivation of implantable cardioverter-defibrillators (ICDs).
RESULTS RESULTS
"Do not resuscitate" orders were documented in patient records in only 5 of 12 centers (42%). Palliative care teams were engaged for 21 of 153 enrolled patients (13.7%). Among the 51 patients with ICDs, 6 of 17 patients who died (35%) had defibrillator deactivation. Of the 17 patients who died, 13 died in the hospital and 4 died within 6 months after discharge; 1 patient had ICD deactivation supported by palliative care services at home.
CONCLUSIONS CONCLUSIONS
Therapy-limiting practices, including ICD deactivation, are not routine in the Italian centers participating in this study. The results emphasize the importance of integrating palliative care as a simultaneous process with intensive care to address the unmet needs of these patients and their families.

Identifiants

DOI: 10.4037/ajcc2024535 PMID: 38424013
pubmed: 38424013
pii: 32312
doi: 10.4037/ajcc2024535
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

145-148

Informations de copyright

©2024 American Association of Critical-Care Nurses.

Auteurs

Alice Sacco (A)

Alice Sacco is a physician, Cardiac Intensive Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

Matteo Pagnesi (M)

Matteo Pagnesi is a physician, Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.

Simone Frea (S)

Simone Frea is a physician, Intensive Cardiac Care Unit, Città della Salute e della Scienza di Torino, Turin, Italy.

Martina Briani (M)

Martina Briani is a physician, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy.

Carlotta Sorini Dini (CS)

Carlotta Sorini Dini is a physician, Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy.

Maurizio Bertaina (M)

Maurizio Bertaina is a physician, Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.

Marco Marini (M)

Marco Marini is a physician, Department of Cardiovascular Sciences, Clinic of Cardiology, Ospedali Riuniti, Ancona, Italy.

Filippo Trombara (F)

Filippo Trombara is a physician, Centro Cardiologico Monzino, IRCCS, Milan, Italy.

Luca Villanova (L)

Luca Villanova is a physician, Cardiac Intensive Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

Amelia Ravera (A)

Amelia Ravera is a physician, Department of Cardiology, "San Giovanni di Dio e Ruggi D'Aragona" Hopital-University, Salerno, Italy.

Guido Tavazzi (G)

Guido Tavazzi is a physician, Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia Italy Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, Pavia, Italy.

Federico Pappalardo (F)

Federico Pappalardo is a physician, Cardiothoracic and Vascular Anesthesia and Intensive Care, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.

Nuccia Morici (N)

Nuccia Morici is a physician, IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi Onlus, Milan, Italy.

Luciano Potena (L)

Luciano Potena is a physician, Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.

Classifications MeSH